Face transplantation has emerged as reconstructive option for the most challenging facial deformities. A comprehensive analysis of functional outcomes, medical complications, incidence of malignancy, and chronic rejection in face transplantation recipients over an extended follow-up period has not yet been published leaving a notable gap in the literature. We retrospectively collected data of morbidity, rejection, vasculopathy, metabolic side effects, as well as functional outcome of sensory return, facial motor function, and speech from 9 patients who underwent face transplantation at Brigham and Women's Hospital between 2009 and 2020. The median follow-up was 120 months (54 and 154 months). Four grafts (40%) developed signs of clinical and histopathologic chronic rejection without evidence of vasculopathy on computed tomography angiograms. Sensory return assessed with Weinstein enhanced sensory testing-monofilament showed an increase in 6 patients (66.7%), and facial expression analysis showed improvement throughout the whole cohort at their most recent follow-up. Speech intelligibility was stable or increasing for 5 patients (55.6%). In conclusion, the long-term outcomes reveal promising results in terms of overall graft retention and functional recovery. Metabolic, malignant, and infectious complications, as well as graft rejection episodes, are expected to occur in this population, and some may be related to patient's age and lifestyle.

This study seeks to evaluate the epidemiology of pickleball upper/lower extremity injuries presenting to US emergency departments (E.D). The National Electronic Injury and Surveillance System (NEISS) database was queried from 2003-2022 to identify patients presenting to the ED with injuries sustained during 'pickleball' to upper/lower extremities. Patients were subsequently divided into pediatric, adult, and geriatric age groups. Demographic and clinical variables were assessed among age groups utilizing two-proportion z-tests with Bonferroni correction. A total of 749 patients with extremity pickleball injuries were identified from NEISS (33 pediatric, 286 adult, 430 geriatric). Pickleball extremity injuries dramatically increased from 2012 to 2022 by 3,650%. Geriatric and pediatric patients had greater frequencies of upper extremity injuries relative to adults (60.2% vs. 40.6%; p < 0.001 and 63.6% vs 40.6%; p = 0.022, respectively). Adults had a significantly greater frequency of lower extremity injuries (59.4%) relative to both pediatric (36.4%; p = 0.022) and geriatric (39.8%; p < 0.001) patients. Patients who were hospitalized after injury were significantly older (68.8 vs. 62.5; p = 0.033) and most commonly incurred a fracture (88.9% vs 34.8%; p < 0.001). This study provides a critical epidemiological analysis of injury trends captured in this popular sport.

Burn injuries pose a significant source of patient morbidity/mortality and reconstructive challenges for burn surgeons, especially in vulnerable populations such as geriatric patients. Our study aims to provide new insights into burn epidemiology by analyzing the largest national, multicenter sample of geriatric patients to date. Using the National Electronic Injury and Surveillance System (NEISS) database (2004-2022), individuals with a “burn” diagnosis were extracted and divided into 2 comparison age groups of 18-64 and 65+. Variables including sex, race, affected body part, incident location, burn etiology, and clinical outcomes were assessed between the 2 groups using 2 proportion z-tests. About 60,581 adult patients who sustained burns were identified from the NEISS database with 6630 of those patients categorized as geriatric (65+). Geriatric patients had a significantly greater frequency of scald burns (36.9% vs 35.4%; P < .01), and third-degree/full-thickness burns (10.4% vs 5.5%, P < .01) relative to nongeriatric adult patients with most of these burns occurring at home (75.9% vs 67.4%; P < .01). The top 5 burn sites for geriatric patients were the hand, face, foot, lower arm, and lower leg and the top 5 burn injury sources were hot water, cookware, oven/ranges, home fires, and gasoline. Geriatric patients had over 2 times greater risk of hospital admission (odds ratio [OR]: 2.32, 95% CI: 2.17-2.49, P < .01) and over 5 times greater risk of emergency department mortality (OR: 6.22, 95% CI: 4.00-9.66, P < .01) after incurring burn injuries. These results highlight the need for stronger awareness of preventative measures for geriatric burn injuries.

Purpose: A major concern for patients undergoing facial transplantation relates to postoperative appearance. This study leverages artificial intelligence (AI) visual analysis software to provide an objective assessment of perceived age and degree of resemblance to the donor. Methods: Postoperative images of 15 face transplant patients were analyzed by Visage Technologies Visage|SDK™ AI facial analysis software to determine perceived age. A subgroup of eight face transplant patients, for which donor and patient pretrauma photographs were available, was analyzed using the same software to determine the percent similarity match to the patients' postoperative image. Mann-Whitney and Wilcoxon rank sum tests were utilized to evaluate for perceived age and facial recognition matching percentage, respectively. Results: AI perceived age was significantly more similar to the patient age (±3.5 years) than the donor age (±9.5, P = 0.0188). For facial resemblance, patients had a significantly higher average percent similarity match to their donor's face compared to their pretrauma native face (63% vs 57%, P = 0.0391). Conclusions: Although patients more closely resembled their donor's resemblance posttransplantation, their perceived age correlated more significantly with their actual age than their donor allograft age. The findings of this study provide a helpful framework for counseling prospective patients on their expected appearance postoperatively.

The purpose of this study is to provide a comprehensive overview of the epidemiology of traumatic craniofacial injuries in the U.S. that occur in the context of drugs and/or alcohol. The National Electronic Injury and Surveillance System (NEISS) database was queried from 2019 to 2022 to identify all emergency department (ED) patients with reported traumatic injuries involving craniofacial anatomy. Clinical and demographic variables were assessed between cases that involved drugs/alcohol and those that did not, utilizing two-proportion z-tests. In total, 441,764 patients with traumatic craniofacial injuries were identified, with 20,285 cases involving drugs and/or alcohol. Cases involving drugs/alcohol had a significantly higher frequency of internal injuries (45.3% vs. 34.9%, p < 0.001), fractures (7.0% vs. 3.4%, p < 0.001), and hematomas (4.6% vs. 2.5%, p < 0.001) than those that did not. Craniofacial injuries involving drugs/alcohol also had a significantly higher frequency of falls to the floor (19.2% vs. 11.8%, p < 0.001) and down stairs/steps (18.3% vs. 6.6%, p < 0.001) and resulted in a significantly greater odds of hospital admission after ED presentation (OR 3.75, 95% CI: 3.63–3.88, p < 0.001). Ultimately, these epidemiological findings can be leveraged to provide clinicians invaluable qualitative context for the most frequent presentations of craniofacial injuries they can anticipate to treat among intoxicated patients.